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  • 251. Eriksson, Jonas
    et al.
    Ekerljung, Linda
    Bossios, Apostolos
    Bjerg, Anders
    Wennergren, Göran
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. The OLIN Studies, Department of Medicine, Sunderby Central Hospital of Norrbotten, Luleå.
    Torén, Kjell
    Lötvall, Jan
    Lundbäck, Bo
    Aspirin-intolerant asthma in the population: prevalence and important determinants2015In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 45, no 1, p. 211-219Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Population-based studies on aspirin-intolerant asthma are very few and no previous population study has investigated risk factors for the condition.

    OBJECTIVE: To investigate the prevalence and risk factors of aspirin-intolerant asthma in the general population.

    METHODS: A questionnaire on respiratory health was mailed to 30 000 randomly selected subjects aged 16-75 years in West Sweden, 29 218 could be traced and 18 087 (62%) responded. The questionnaire included questions on asthma, respiratory symptoms, aspirin-induced dyspnea and possible determinants.

    RESULTS: The prevalence of aspirin-intolerant asthma was 0.5%, 0.3% in men and 0.6% in women (p=0.014). Sick leave, emergency visits due to asthma and all investigated lower respiratory symptoms were more common in aspirin-intolerant asthma than in aspirin-tolerant asthma. Obesity was a strong risk factor for aspirin-intolerant asthma (BMI>35: OR 12.1; 95% CI 2.49-58.5) and there was a dose-response relationship between increasing body mass index and risk of aspirin-intolerant asthma. Obesity, airborne occupational exposure and visible mold at home were considerably stronger risk factors for aspirin-intolerant asthma than for aspirin-tolerant asthma. Current smoking was a risk factor for aspirin-intolerant asthma (OR 2.55; 95% CI 1.47-4.42), but not aspirin-tolerant asthma.

    CONCLUSION: Aspirin-intolerant asthma identified in the general population was associated with a high burden of symptoms, uncontrolled disease and a high morbidity. Increasing body mass index increased the risk of aspirin-intolerant asthma in a dose-response manner. A number of risk factors, including obesity and current smoking, were considerably stronger for aspirin-intolerant asthma than for aspirin-tolerant asthma.

  • 252.
    Eriksson, Jonas
    et al.
    Department of Internal Medicine/Krefting Research Centre Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Ekerljung, Linda
    Department of Internal Medicine/Krefting Research Centre Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Pullerits, Teet
    Department of Internal Medicine/Krefting Research Centre Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Holmberg, Kenneth
    Department of Internal Medicine/Respiratory Medicine and Allergology, Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Internal Medicine/Krefting Research Centre ; The OLIN Studies, Department of Medicine, Sunderby Central Hospital of Norrbotten, Luleå.
    Lötvall, Jan
    Department of Internal Medicine/Krefting Research Centre Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Lundbäck, Bo
    Department of Internal Medicine/Krefting Research Centre Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Prevalence of chronic nasal symptoms in West Sweden: risk factors and relation to self-reported allergic rhinitis and lower respiratory symptoms2011In: International Archives of Allergy and Immunology, ISSN 1018-2438, E-ISSN 1423-0097, Vol. 154, no 2, p. 155-163Article in journal (Refereed)
    Abstract [en]

    Background: There are few population-based studies on chronic nasal symptoms and little is known about their prevalence and determinants, or their association with allergic rhinitis and asthma.

    Methods: A questionnaire focused on respiratory symptoms and conditions was mailed in 2008 to 30,000 randomly selected subjects aged 16-75 years in West Sweden, 29,218 could be traced and 18,087 (62%) responded. The questionnaire included questions on self-reported allergic rhinitis, asthma, lower respiratory and nasal symptoms and possible determinants.

    Results: Nasal congestion was reported by 14.9% and runny nose by 13.1% of subjects. In total, 19.8% had chronic nasal symptoms. Subjects with chronic nasal symptoms had considerably more symptoms from the lower airways compared with nonrhinitic subjects and vice versa. Forty-seven percent of the subjects with chronic nasal symptoms had concurrent self-reported allergic rhinitis. Several hereditary and environmental factors were associated with chronic rhinitis, including family history of asthma [odds ratio (OR) 1.27; 95% confidence interval 1.07-1.50], family history of allergy (OR 1.74; 1.57-1.92) and current smoking (OR 1.39; 1.25-1.54). Further, chronic nasal symptoms were increasingly prevalent with an increasing degree of urbanization.

    Conclusion: The prevalence of chronic nasal symptoms in West Sweden was found to be high and strongly associated both with self-reported allergic rhinitis and symptoms from the lower airways. Moreover, several risk factors were identified for chronic nasal symptoms, including family history of allergy and asthma and smoking.

  • 253. Eriksson, Jonas
    et al.
    Ekerljung, Linda
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Dahlen, Barbro
    Ahlstedt, Staffan
    Dahlen, Sven-Erik
    Lundback, Bo
    Update of prevalence of self-reported allergic rhinitis and chronic nasal symptoms among adults in Sweden2012In: Clinical Respiratory Journal, ISSN 1752-6981, E-ISSN 1752-699X, Vol. 6, no 3, p. 159-168Article in journal (Refereed)
    Abstract [en]

    Background: Allergic rhinitis (AR) is the most common immunologic disease, and it renders a considerable burden on both sufferers and society. The prevalence of AR has been increasing worldwide over the past century. The aim of this study was to assess the present prevalence, risk factor patterns and comorbidity of self-reported AR and chronic nasal symptoms in different age groups in Stockholm, Sweden. Methods: A postal questionnaire was sent on two occasions, in 2006 to a population aged 30-80 years, randomly selected 10 years previously, and in 2007 to a randomly selected sample of subjects aged 20-69 years. The response rates were 83% and 68%, respectively, and in total, 9792 subjects participated. The questionnaire included questions on self-reported AR, asthma, respiratory and nasal symptoms and possible determinants. Results: The prevalence of self-reported AR was 28.0% (men 26.6%, women 29.1%, P < 0.01) similar to 10 years previously and 33.6% in ages 3040 years. Allergic heredity [odds ratio (OR) 4.76, confidence interval (CI) 95% 4.255.33], physician-diagnosed asthma (OR 5.29, CI 95% 4.496.24) and occupational exposure to dust, gases and fumes (OR 1.49, CI 95% 1.301.72) were determinants for AR. Prevalence of chronic nasal congestion was 16.1% and of chronic rhinorrhea 14.1%. Conclusions: As a basis for understanding the disease, as well as in planning and prioritising health-care resources, the study provides information about the current prevalence and determinants of self-reported AR and chronic nasal symptoms. Further, comparing with previous studies, the present study suggests that a plateau in the prevalence of AR may have been reached in Sweden. Please cite this paper as: Eriksson J, Ekerljung L, Ronmark E, Dahlen B, Ahlstedt S, Dahlen S-E and Lundback B. Update of prevalence of self-reported allergic rhinitis and chronic nasal symptoms among adults in Sweden. Clin Respir J 2012; 6: 159168.

  • 254.
    Eriksson, Kåre
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Bryngelsson, Ing-Liss
    Hagström, Katja
    Temporal Trend in Wood Dust Exposure During the Production of Wood Pellets2017In: Annals of work exposures and health, ISSN 2398-7316, Vol. 61, no 4, p. 429-439Article in journal (Refereed)
    Abstract [en]

    Objective: Wood dust data collected in the production of wood pellets during 2001 to 2013 were evaluated to study a temporal trend in inhalation exposure.

    Methods: A linear mixed effects model of natural ln-transformed data was used to express the relative annual difference in inhalation wood dust exposure.

    Results: There was an annual decrease of -20.5% of the geometric mean wood dust exposure during 2001 until 2013. The results were based on 617 inhalable dust samples collected at 14 different production units. The exposure to wood dust at the industrial premises investigated has decreased from a relatively high level of 6.4 mg m-3 in 2001 to 1.0 mg-3 in 2013. The Swedish Occupational Exposure Limit (SOEL) of 2 mg m-3 may still be exceeded.

    Conclusion: Analysis of the temporal trend in soft wood production units revealed declines in exposure of 20.5% per annum. It is important that precautions are taken to protect workers from a hazardous exposure to wood dust at the premises as the SOEL of 2 mg m-3 at some occasions is still exceeded. Additional measurements of wood dust exposure should be carried out on a regular basis in wood pellet production units in Sweden as well in other countries.

  • 255.
    Eriksson, Kåre
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Hagström, Katja
    Axelsson, Sara
    Nylander-French, Leena
    Tape-stripping as a method for measuring dermal exposure to resin acids during wood pellet production.2008In: Journal of Environmental Monitoring, ISSN 1464-0325, E-ISSN 1464-0333, Vol. 10, no 3, p. 345-52Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to develop a sensitive and specific method for quantifying dermal exposure to the resin acids 7-oxodehydroabietic acid (7-OXO), dehydroabietic acid (DHAA), abietic acid (AA), and pimaric acid (PA). In addition the method was evaluated in occupational settings during production of wood pellets. Tape-strips were spiked with the substances to evaluate the recovery of the acids from the tape. The removal efficiency of the tape was assessed by tape-stripping a specified area on a glass plate spiked with resin acids. The recovery of the acids from human skin in vivo was evaluated by applying acids in methanol onto the skin of volunteers. Occupational dermal exposure to the resin acids was assessed by tape-stripping the skin of workers involved in the production of wood pellets. The resin acids were analyzed by liquid chromatography mass spectrometry (LC-MS). The limit of detection was 15 pg (7-OXO), 150 pg (DHAA), 285 pg (AA) and 471 pg (PA) per injection. The recovery from spiked tapes was in general 100%. The removal efficiency of the tape was 48-101%. Recovery tests from human skin in vivo showed a mean recovery of 27%. Quantifiable amounts of resin acids were observed on four different skin areas with an increase in exposure during a work shift. This study shows that occupational dermal exposure to resin acids can be assessed by tape-stripping and quantified by LC-MS.

  • 256.
    Eriksson, Kåre
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Liljelind, Ingrid
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Fahlén, Jessica
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics.
    Lampa, Erik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Should styrene be sampled on the left or right shoulder?: An important question in employee self-assessment.2005In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 49, no 6, p. 529-533Article in journal (Refereed)
    Abstract [en]

    A self-operated personal sampling technique called 'self assessment of exposure' (SAE) has been suggested as an easy method for collecting inhalation exposure data, as the workers themselves are performing the sampling. Employers and employees have raised the question of whether a different estimate of the air concentration is likely to be obtained depending on whether the sampler is fastened at the left or the right shoulder. In order to answer this question, the exposure to styrene vapour in two different small enterprises within the reinforced plastics industry was measured. Seven workers participated and the air sampling was performed by diffusive sampling. We observed no statistically significant difference in the determined air concentration of styrene between the left and right shoulder (P = 0.878). The results strongly indicate that the fastening of a sampler on the left or right shoulder does not produce a difference in the estimation of the inhalation exposure. SAE can thus be used to collect reliable exposure data of styrene vapour. The reliability of SAE will most certainly inspire occupational hygienists, physicians and other experts to involve the workers in repeated exposure measurements. Taking the exposure variability into account, repeated measurements are crucial when evaluating acute and chronic health effects following inhalation exposure to gases and vapours from chemical hazards.

  • 257.
    Eriksson, Kåre
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wiklund, Leif
    Dermal exposure to monoterpenes during wood work.2004In: Journal of Environmental Monitoring, ISSN 1464-0325, E-ISSN 1464-0333, Vol. 6, no 6, p. 563-8Article in journal (Refereed)
    Abstract [en]

    The dermal exposure to the suspected allergenic monoterpenes [small alpha]-pinene, [small beta]-pinene and [capital Delta](3)-carene was assessed with a patch sampling technique. The patch used was made of activated charcoal sandwiched between two layers of cotton cloth. Patches were fastened at 12 different spots on a sampling overall and at the front of a cap to estimate the potential exposure of the body. Fastening two patches on a cotton glove, one patch representing the dorsal side and one patch representing the palm of the hand respectively, assessed the exposure on the hands. Sampling was carried out during collecting of pine and spruce boards in sawmills and during sawing of pine wood pieces in joinery shops respectively. The potential dermal exposure of the total body was 29.0-1 890 mg h(-1) with a geometric mean (GM) of 238 mg h(-1) during sawing. During collecting the GM was estimated to 100 mg h(-1) with a range of 12.2-959 mg h(-1). The hands had a mean exposure of 9.24 mg h(-1) during sawing and 3.25 mg h(-1) during collecting respectively. The good correlation between the mass of contamination on the individual body parts and the potential body exposure indicates that sampling can be performed on one body part to give a good estimation of the potential body exposure. Monoterpenes were detected at patches fastened underneath the protective clothing indicating a contamination of the skin of the worker. The patch used may overestimate the dermal exposure.

  • 258.
    Eriksson, Kåre
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Wiklund, Leif
    Dermal exposure to styrene in the fibreglass reinforced plastics industry.2004In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 48, no 3, p. 203-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to assess the potential dermal exposure to styrene in the fibreglass reinforced plastics industry. METHODS: Assessment was performed during spraying and rolling using a patch sampling technique. The patch was made of charcoal sandwiched between two layers of cotton fabric. Samplers were fastened at 12 different spots on a sampling overall, each spot representing a body area. One patch was fastened at the front of a cap. A patch fastened to a string worn around the neck assessed the exposure at chest level inside the clothing. Patches were fastened to cotton gloves at sites representing the dorsal side and the palm of the hand to evaluate exposure on these areas. Following sampling the patches were solvent desorbed and styrene was analysed by gas chromatography flame ionization detection. RESULTS: The potential body exposure for the participating individuals was between 544 and 17 100 mg/h with a geometric mean (GM) of 3780 mg/h. The legs, arms and outer chest in general had the highest exposures. The left and right hands had mean (GM) exposures of 344 and 433 mg/h, respectively. Styrene was determined for the patch at the inside of the clothing, indicating contamination of the dermal layer. CONCLUSIONS: The charcoal patch can be used to evaluate potential exposure to styrene. The results indicate that the dermal layer of the worker is exposed to styrene. Precautions should be performed to reduce dermal exposure.

  • 259.
    Eriksson, Kåre
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wiklund, Leif
    Larsson, Cecilia
    National Institute for Working Life, Umeå.
    Levin, Jan-Olof
    National Institute for Working Life, Umeå.
    Dermal exposure to terpenic resin acids in Swedish carpentry workshops and sawmills2004In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 48, no 3, p. 267-275Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to evaluate dermal exposure to the resin acids abietic acid, dehydroabietic acid and 7-oxodehydroabietic acid during collecting in sawmills and during sawing in carpentry workshops, respectively. METHODS: Sampling was performed by fastening patches at 12 different areas on a sampling overall, one patch on the front of a cap, one patch on the chest inside the clothing and one patch on the inner lower right leg. Exposure of the hands was assessed by fastening patches on cotton gloves representing the dorsal sides and the palms of the left and right hands. Sampling was performed on 30 different occasions in the sawmills and in the carpentry workshops with mean sampling times of 120 and 59 min, respectively. The acids were solvent desorbed from the patches. Identification and quantification of the resin acids was performed by gas chromatography-mass spectrometry. RESULTS: The geometric means (GMs) of the potential body exposures to abietic acid, dehydroabietic acid and 7-oxodehydroabietic acid during sawing and collecting of wood from pine and spruce were 3346 and 17 247 micro g/h, respectively. The GM of the potential exposure on the hands was 3020 micro g/h in the carpentry workshops and 4365 micro g/h in the sawmills. Resin acids were detected on the inner chest and inner lower front right leg, respectively. CONCLUSIONS: There is a potential dermal exposure to terpenic resin acids in carpentry workshops as well as in sawmills. The hands have the highest exposure during sawing as well as during collecting. There is a spatial distribution of contaminants, with the outer chest, arms and legs showing the highest exposures. Resin acids also contaminated the inner chest and inner lower leg. It is necessary to take action to reduce dermal exposure to these allergenic substances.

  • 260.
    Eriksson, Kåre
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Östin, Anders
    National Institute for Working Life, Umeå.
    Levin, Jan-Olof
    National Institute for Working Life, Umeå.
    Quantification of melatonin in human saliva by liquid chromatography-tandem mass spectrometry using stable isotope dilution2003In: Journal of chromatography. B, ISSN 1570-0232, E-ISSN 1873-376X, Vol. 794, no 1, p. 115-123Article in journal (Refereed)
    Abstract [en]

    A method for the determination of melatonin in human saliva has been developed using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS-MS). Saliva was collected in plastic tubes. 7-D-Melatonin was added as internal standard and the samples were cleaned and concentrated by solid-phase extraction. The limit of detection was 1.05 pg x ml(-1) and the limit of quantification was 3.0 pg x ml(-1). The accuracy of the method was +/-14% at 5.60 pg x ml(-1) and +/-9% at 19.6 pg x ml(-1). The precision was +/-13% at 6.18 pg x ml(-1) and +/-11% at 31.2 pg x ml(-1), respectively. Our HPLC-MS-MS method shows a high sensitivity and specificity for melatonin and more reliable results compared with a radioimmunoassay. The chromatographic method has been used to determine the circadian rhythm of melatonin among three nurses working the night shift and a patient suffering from an inability to fall asleep at night.

  • 261.
    Eriksson, Maija
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nääs, Sofia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Berginström, Nils
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Hansson, Patrik
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. School of Sport Sciences, The Arctic University of Norway, Tromsø, Norway.
    Sedentary behavior as a potential risk factor for depression among 70-year-olds2019In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517Article in journal (Refereed)
    Abstract [en]

    Background: Sedentary behavior has previously been associated with the risk of depression. In addition, older adults have been proven to be more sedentary and more depressed than other age groups. However, studies using objective measures of sedentary behavior and taking physical activity into account are lacking. Thus, the purpose of this population-based study was to examine how total sedentary time and length of sedentary bouts were associated with the risk of depression among 70-year-olds.

    Methods: The present study used data from the Healthy Ageing Initiative (n = 3,633), an ongoing cross-sectional research project in Umeå, Sweden. Sedentary behavior was measured objectively with the ActiGraph GT3X+ accelerometer, and depression was measured with the Geriatric Depression Scale. Several covariates, including physical activity, were included in logistic regression analyses.

    Results: Results from two hierarchical logistic regression models showed that a greater percentage of the day spent sedentary [odds ratio (OR) = 1.031, p = 0.010] and longer average length of sedentary bouts (OR = 1.116, p = 0.045) increased the risk of depression.

    Limitations: Limitations include of possible underrepresentation of severely depressed participants, and possible observer effects.

    Conclusions: The present study verified the relationship between sedentary behavior and depression and provides new information about the risks associated with increased length of sedentary bouts.  These findings may be important to consider in the development of future recommendations for the prevention of depression among older adults.

  • 262.
    Eskilsson, Therese
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Malmberg Gavelin, Hanna
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Stigsdotter Neely, Anna
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre.
    Aerobic training for improved memory in patients with stress-related exhaustion: a randomized controlled trial2017In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, no 1, article id 322Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with stress-related exhaustion suffer from cognitive impairments, which often remain after psychological treatment or work place interventions. It is important to find effective treatments that can address this problem. Therefore, the aim of this study was to investigate the effects on cognitive performance and psychological variables of a 12-week aerobic training program performed at a moderate-vigorous intensity for patients with exhaustion disorder who participated in a multimodal rehabilitation program.

    METHODS: In this open-label, parallel, randomized and controlled trial, 88 patients diagnosed with exhaustion disorder participated in a 24-week multimodal rehabilitation program. After 12 weeks in the program the patients were randomized to either a 12-week aerobic training intervention or to a control group with no additional training. Primary outcome measure was cognitive function, and secondary outcome measures were psychological health variables and aerobic capacity.

    RESULTS: In total, 51% patients in the aerobic training group and 78% patients in the control group completed the intervention period. The aerobic training group significantly improved in maximal oxygen uptake and episodic memory performance. No additional improvement in burnout, depression or anxiety was observed in the aerobic group compared with controls.

    CONCLUSION: Aerobic training at a moderate-vigorous intensity within a multimodal rehabilitation program for patients with exhaustion disorder facilitated episodic memory. A future challenge would be the clinical implementation of aerobic training and methods to increase feasibility in this patient group.

    TRIAL REGISTRATION: ClinicalTrials.gov: NCT03073772 . Retrospectively registered 21 February 2017.

  • 263. Espín-Pérez, Almudena
    et al.
    Hebels, Dennie G. A. J.
    Kiviranta, Hannu
    Rantakokko, Panu
    Georgiadis, Panagiotis
    Botsivali, Maria
    Bergdahl, Ingvar
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Palli, Domenico
    Späth, Florentin
    Umeå University, Faculty of Medicine, Department of Biobank Research. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Johansson, Anders
    Umeå University, Faculty of Medicine, Department of Biobank Research. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Chadeau-Hyam, Marc
    Kyrtopoulos, Soterios A
    Kleinjans, Jos C. S.
    de Kok, Theo M. C. M.
    Identification of Sex-Specific Transcriptome Responses to Polychlorinated Biphenyls (PCBs)2019In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 746Article in journal (Refereed)
    Abstract [en]

    PCBs are classified as xenoestrogens and carcinogens and their health risks may be sex-specific. To identify potential sex-specific responses to PCB-exposure we established gene expression profiles in a population study subdivided into females and males. Gene expression profiles were determined in a study population consisting of 512 subjects from the EnviroGenomarkers project, 217 subjects who developed lymphoma and 295 controls were selected in later life. We ran linear mixed models in order to find associations between gene expression and exposure to PCBs, while correcting for confounders, in particular distribution of white blood cells (WBC), as well as random effects. The analysis was subdivided according to sex and development of lymphoma in later life. The changes in gene expression as a result of exposure to the six studied PCB congeners were sex- and WBC type specific. The relatively large number of genes that are significantly associated with PCB-exposure in the female subpopulation already indicates different biological response mechanisms to PCBs between the two sexes. The interaction analysis between different PCBs and WBCs provides only a small overlap between sexes. In males, cancer-related pathways and in females immune system-related pathways are identified in association with PCBs and WBCs. Future lymphoma cases and controls for both sexes show different responses to the interaction of PCBs with WBCs, suggesting a role of the immune system in PCB-related cancer development.

  • 264. Finnbjornsdottir, Ragnhildur Gudrun
    et al.
    Carlsen, Hanne Krage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Centre of Public Health Sciences, University of Iceland, Stapi, v/Hringbraut, 101 Reykjavik, Iceland.
    Thorsteinsson, Throstur
    Oudin, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lund, Sigrun Helga
    Gislason, Thorarinn
    Rafnsson, Vilhjalmur
    Association between Daily Hydrogen Sulfide Exposure and Incidence of Emergency Hospital Visits: A Population-Based Study2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 5, article id e0154946Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The adverse health effects of high concentrations of hydrogen sulfide (H2S) exposure are well known, though the possible effects of low concentrations have not been thoroughly studied. The aim was to study short-term associations between modelled ambient low-level concentrations of intermittent hydrogen sulfide (H2S) and emergency hospital visits with heart diseases (HD), respiratory diseases, and stroke as primary diagnosis.

    METHODS: The study is population-based, using data from patient-, and population-registers from the only acute care institution in the Reykjavik capital area, between 1 January, 2007 and 30 June, 2014. The study population was individuals (≥18yr) living in the Reykjavik capital area. The H2S emission originates from a geothermal power plant in the vicinity. A model was used to estimate H2S exposure in different sections of the area. A generalized linear model assuming Poisson distribution was used to investigate the association between emergency hospital visits and H2S exposure. Distributed lag models were adjusted for seasonality, gender, age, traffic zones, and other relevant factors. Lag days from 0 to 4 were considered.

    RESULTS: The total number of emergency hospital visits was 32961 with a mean age of 70 years. In fully adjusted un-stratified models, H2S concentrations exceeding 7.00μg/m3 were associated with increases in emergency hospital visits with HD as primary diagnosis at lag 0 risk ratio (RR): 1.067; 95% confidence interval (CI): 1.024-1.111, lag 2 RR: 1.049; 95%CI: 1.005-1.095, and lag 4 RR: 1.046; 95%CI: 1.004-1.089. Among males an association was found between H2S concentrations exceeding 7.00μg/m3, and HD at lag 0 RR: 1.087; 95%CI: 1.032-1.146 and lag 4 RR: 1080; 95%CI: 1.025-1.138; and among those 73 years and older at lag 0 RR: 1.075; 95%CI: 1.014-1.140 and lag 3 RR: 1.072; 95%CI: 1.009-1.139. No associations were found with other diseases.

    CONCLUSIONS: The study showed an association between emergency hospital visits with HD as primary diagnosis and same day H2S concentrations exceeding 7.00μg/m3, more pronounced among males and those 73 years and older than among females and younger individuals.

  • 265. Finnbjornsdottir, Ragnhildur Gudrun
    et al.
    Oudin, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Elvarsson, Bjarki Thor
    Gislason, Thorarinn
    Rafnsson, Vilhjalmur
    Hydrogen sulfide and traffic-related air pollutants in association with increased mortality: a case-crossover study in Reykjavik, Iceland2015In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 4, article id e007272Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To study the association between daily mortality and short-term increases in air pollutants, both traffic-related and the geothermal source-specific hydrogen sulfide (H2S).

    DESIGN: Population-based, time stratified case-crossover. A lag time to 4 days was considered. Seasonal, gender and age stratification were calculated. Also, the best-fit lag when introducing H2S >7 µg/m(3) was selected by the Akaike Information Criterion (AIC).

    SETTING: The population of the greater Reykjavik area (n=181 558) during 2003-2009.

    PARTICIPANTS: Cases were defined as individuals living in the Reykjavik capital area, 18 years or older (N=138 657), who died due to all natural causes (ICD-10 codes A00-R99) other than injury, poisoning and certain other consequences of external causes, or cardiovascular disease (ICD-10 codes I00-I99) during the study period.

    MAIN OUTCOME MEASURE: Percentage increases in risk of death (IR%) following an interquartile range increase in pollutants.

    RESULTS: The total number of deaths due to all natural causes was 7679 and due to cardiovascular diseases was 3033. The interquartile range increased concentrations of H2S (2.6 µg/m(3)) were associated with daily all natural cause mortality in the Reykjavik capital area. The IR% was statistically significant during the summer season (lag 1: IR%=5.05, 95% CI 0.61 to 9.68; lag 2: IR%=5.09, 95% CI 0.44 to 9.97), among males (lag 0: IR%=2.26, 95% CI 0.23 to 4.44), and among the elderly (lag 0: IR%=1.94, 95% CI 0.12 to 1.04; lag 1: IR%=1.99, 95% CI 0.21 to 1.04), when adjusted for traffic-related pollutants and meteorological variables. The traffic-related pollutants were generally not associated with statistical significant IR%s.

    CONCLUSIONS: The results suggest that ambient H2S air pollution may increase mortality in Reykjavik, Iceland. To the best of our knowledge, ambient H2S exposure has not previously been associated with increased mortality in population-based studies and therefore the results should be interpreted with caution. Further studies are warranted to confirm or refute whether H2S exposure induces premature deaths.

  • 266.
    Fjellman-Wiklund, Anncristine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stenlund, Therese
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Steinholtz, Katarina
    The Stress Clinic, University Hospital of Umeå.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Take charge: Patients' experiences during participation in a rehabilitation programme for burnout2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 5, p. 475-481Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to explore the experiences of patients with burnout during a rehabilitation programme.

    Patients and methods: Eighteen patients with burnout were interviewed at the end of a one-year rehabilitation programme. The programme consisted of 2 groups, one with a focus on cognitively-oriented behavioural rehabilitation and Qigong and 1 with a focus on Qigong alone. The interviews were analysed using the grounded theory method.

    Results: One core category, Take Charge, and 6 categories emerged. The core category represents a beneficial recovery process that helped the patients to take control of their lives. The common starting point for the process is presented in the 3 categories of Good encounters, Affirmation and Group cohesiveness. The categories were basic conditions for continuing development during rehabilitation. In the categories Get to know myself, How can I be the one I want to be? and Choice of track, the more group-specific tools are included, through which the patients adopted a new way of behaving.

    Conclusion: Patients in both groups experienced group participation as being beneficial for recovery and regaining control of their lives, although in somewhat different way. An experience of affirmation and support from health professionals and group participants is of importance for behavioural change

  • 267.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Klimatförändring och hälsorelaterad miljöövervakning: - redovisning av utredningsuppdrag2009Report (Other academic)
  • 268.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Slutrapport från pilotstudie Uppskattning av exponering för ozon2014Report (Other academic)
    Abstract [sv]

    Syftet med denna pilotstudie var att genomföra en undersökning angående ozonexponering under ”ozonsäsongen” (dvs maj-september) 2013 inne i skolor och utanför på skolgården samt i sovrummet hos skolbarn och i utomhus bostadens närhet. Pilotstudien ska ge vägledning angående kriterier och uppläggning vid mätning av ozon, samt leda till ett förslag till mätprogram för ozonexponering med fokus på ozonsäsongen och barns miljöer.

    För skolmätningen valdes 10 representativa skolor ut. Ozonprovtagare placerades öppet i två klassrum per skola, oftast på ca 2 m höjd, t ex ovanför en hylla. En provtagare placerades på en öppen plats på skolgården. Mätningarna pågick under samma veckolånga period inomhus och utomhus, alla skolmätningarna startades 13-14 maj. Vi en sköterska inbjöds skolbarn med astma att ingå i bostadsmätningarna”, och 25 tackade efter att ha fått skriftlig information ja till att medverka i studien. Skolornas och bostädernas avgasbelastning har indikerats med en modellberäkning av lokalt trafikgenererad halt av NOx/NO2. På skolgårdarna var veckomedelhalten i genomsnitt 67,4 μg/m3. Det var stora skillnader i utomhushalten av ozon mellan mitten på maj då mätningarna på de 10 skolgårdarna utfördes, och i slutet av september då bostadsområdena studerades. I klassrummen varierade ozonhalten från 12,3 till 48,1 μg/m3, med ett medelvärde på 23.3 μg/m3. I barnens sovrum fanns nästan inget ozon alls. Medelvärdet var 2,1 μg/m3 och spridningen från 0,4 till 5,8 μg/m3. Det observerades inget samband mellan ozonhalten inomhus och utomhus, vilket torde bero på liten ventilation och att ozon är så reaktivt. Utifrån denna pilotstudie kan kostateras att mätningarna för att spegla den mest intressanta exponeringen för ozon bör ske under sommaren, vilket om skolbarn ska inkluderas förmodligen innebär att det vore lättast att göra studien under slutet av vårterminen.

  • 269.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    [Soot particles make the air hazardous--again]2007In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 48, p. 3652-5Article in journal (Refereed)
  • 270.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Stockholmsförsöket har folkhälsopotential2006In: Läkartidningen, no 103, p. 50-52Article in journal (Refereed)
  • 271.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Traffic related PM and mortality: exposure-response functions and impact calculations for TESS2008Report (Other academic)
    Abstract [en]

    This is a report from the research project TESS – Traffic Emissions, Socio-economic valuation and Socio-economic measures, which is funded by EMFO. In 2002 an agreement about the EMFO program was reached between the partners from the Swedish Vehicle Research Council, PFF. EMFO is a sector-wide research competence to develop vehicles and vehicle components with emission levels that are sustainable in the long term. The aim of EMFO is to offer academia, industry and authorities access to necessary knowledge and pioneering solutions that are necessary if vehicle technology is to develop in the desired direction. One important task is to coordinate activities within the program with both national and international research in the field. EMFO comprises subsidiary programs and two of these were: “Socio-economic evaluation of the health and environmental impact of different emissions” and “Optimal range of socio-economic measures”. TESS undertakes research in these two areas but it is also related to the subsidiary program: “Health and Environmental Impact”. The application was approved in 2005 and the project runs during 2005-2008. The basis for the research in TESS is the valuation methods developed in the EU funded ExternE projects where the external cost of emissions is calculated by tracing the effects that the emissions have on human health and then valuing these effects. The aim is to calculate the external costs related to particles that local emissions (from traffic and other sources) generate on a local and regional scale using Stockholm as a case study. Based on this information an analysis will be made on what reductions measures are likely to be efficient from an economic point of view. The analysis undertaken in TESS requires collaboration between researchers from different research disciplines. There are four parties involved in this project; VTI, SLB analys (Environment and Health Administration, Stockholm), Umeå University and SMHI. This report is focused on the health impact assessment. The first aim is to overview and discuss the epidemiological basis for selection of an exposure-response function, ERF, (or several different) for traffic related particles and mortality. The second aim is to use the exposure calculations by SLB and SMHI presented in TESS to make impact calculations using the selected exposure-response assumptions for particles of three types; exhaust particles, road dust particles and secondary particles (especially nitrates).

  • 272.
    Forsberg, Bertil
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Bråbäck, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Keune, Hans
    Kobernus, Mike
    Krayer von Krauss, Martin
    Yang, Aileen
    Bartonova, Alena
    An expert assessment on climate change and health: with a European focus on lungs and allergies2012In: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 11, no Supplement 1, p. S4-Article in journal (Refereed)
    Abstract [en]

    Background

    For almost 20 years, the Intergovernmental Panel on Climate Change has been assessing the potential health risks associated with climate change; with increasingly convincing evidence that climate change presents existing impacts on human health. In industrialized countries climate change may further affect public health and in particular respiratory health, through existing health stressors, including, anticipated increased number of deaths and acute morbidity due to heat waves; increased frequency of cardiopulmonary events due to higher concentrations of air pollutants; and altered spatial and temporal distribution of allergens and some infectious disease vectors. Additionally exposure to moulds and contaminants from water damaged buildings may increase.

    Methods

    We undertook an expert elicitation amongst European researchers engaged in environmental medicine or respiratory health. All experts were actively publishing researchers on lung disease and air pollution, climate and health or a closely related research. We conducted an online questionnaire on proposed causal diagrams and determined levels of confidence that climate change will have an impact on a series of stressors. In a workshop following the online questionnaire, half of the experts further discussed the results and reasons for differences in assessments of the state of knowledge on exposures and health effects.

    Results

    Out of 16 experts, 100% expressed high to very high confidence that climate change would increase the frequency of heat waves. At least half expressed high or very high confidence that climate change would increase levels of pollen (50%), particulate matter (PM2.5) (55%), and ozone (70%). While clarity is needed around the impacts of increased exposures to health impacts of some stressors, including ozone and particulate matter levels, it was noted that definitive knowledge is not a prerequisite for policy action. Information to the public, preventive measures, monitoring and warning systems were among the most commonly mentioned preventative actions.

    Conclusions

    This group of experts identifies clear health risks associated with climate change, and express opinions about these risks even while they do not necessarily regard themselves as covering all areas of expertise. Since some changes in exposure have already been observed, the consensus is that there is already a scientific basis for preventative action, and that the associated adaptation and mitigation policies should also be evidence based.

  • 273.
    Forsberg, Bertil
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Burman, Lars
    Johansson, Christer
    [Public health potential of the Stockholm trial. Estimated prevention of 23 premature deaths annually among the inner-city population]2006In: Lakartidningen, ISSN 0023-7205, Vol. 103, no 50-52, p. 4043-5Article in journal (Refereed)
  • 274.
    Forsberg, Bertil
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Hansson, Hans-Christen
    Johansson, Christer
    Areskoug, Hans
    Persson, Karin
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Comparative health impact assessment of local and regional particulate air pollutants in Scandinavia.2005In: Ambio, ISSN 0044-7447, Vol. 34, no 1, p. 11-9Article in journal (Refereed)
  • 275.
    Forsberg, Bertil
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Meister, Kadri
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Segerstedt, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Luftföroreningshalter och akutbesök för astma samt några andra luftvägssjukdomar i Stockholm, Göteborg och Malmö 2001-2005: projektrapport till Naturvårdsverket2008Report (Other academic)
    Abstract [sv]

    Denna studie inom den hälsorelaterade miljöövervakningen har genomförts på uppdrag avNaturvårdsverket för att belysa eventuella korttidseffekter av luftföroreningar på akutbesökför astma och andra sjukdomar i andningsorganen, vilka ofta medför ökad känslighet förluftföroreningar. Halternas samband med sjukhusinläggningar för andningsorganenssjukdomar har tidigare studerats inom miljöövervakningen. För att underlätta jämförelser harmetodiken anpassats till dessa tidigare studier av sjukhusinläggningar, där betydelsen avhalterna de två senaste dygnen beräknas. Övervakning av denna typ av ”akuta samband” medhalter i miljön bedöms mindre känslig än enklare epidemiologisk bevakning av antalet fall förtrender och förändringar i diagnostik och vårdresurser, eftersom totala antalet fall i sig kanpåverkas av en rad olika typer av faktorer utan koppling till luftföroreningssituationen.

    Uppgifter om den skrivna befolkningens akutbesök under åren 2001 till och med 2005 förandningsorganens sjukdomar inklusive astma vid akutsjukhusen i StorStockholm (8 sjukhus),Göteborg och Mölndal respektive Malmö har inhämtats från Socialstyrelsens Patientregister.Uppgifterna från registret avser avidentifierade akutbesök med diagnoser dygn för dygn underperioden.

    Luftföroreningsdata i form av urbana bakgrundshalter har hämtats från Stockholm luft- ochbulleranalys (SLB) vid miljöförvaltningen i Stockholm, Göteborgs miljöförvaltningrespektive Malmö miljöförvaltning. Vi har studerat partikelhalten som PM10, avgashaltenindikerad med kväveoxider (NOx) samt ozon.

    Tidsserieanalyserna har utförts med Poisson-regression. I dessa analyser tas hänsyn tilltidstrender, årstidsmönster, influensaperioder, väderförhållanden, pollenhalt, veckodag,helgperioder mm. De studerade luftföroreningarna är ozon, kvävedioxid och partiklar. Allaluftföroreningsvariabler kan ses som indikatorer på olika typer av luftföroreningar, och har ikombinationer beaktats i de slutliga analyserna.

    Vi fann att resultaten inte skiljer sig signifikant mellan studieområdena beträffande effekternaav partikelhalten som PM10 och NOx, medan vi för ozon fann kraftigare effekter i Göteborg.När resultaten vägdes ihop för de tre studieområdena beräknas att antalet akutbesök förandningsorganen ökar med 1,4% (95% KI= 0,4-2,4%) per 10 μg/m3 PM10 och akutbesök förastma med 2,8% (95% KI= 1,8-3,7%). Motsvarande sammanvägda resultat för NOx visar enökning av totala antalet akutbesök för andningsorganen med 0,5% (95% KI= 0,1-1,0%) per 10μg/m3 och akutbesök för astma med 1,2% (95% KI= 0,4-2,1%).

    Eftersom föroreningssituationen som indikatorerna representerar kan förändras med tiden, böranalyserna upprepas med viss periodicitet.

  • 276.
    Forsberg, Bertil
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Wahlgren, Chatrin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lundström, Nils-Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jonsson, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Eldningsvanor inom några studieområden i Västerbotten2014Report (Other academic)
    Abstract [sv]

    I syfte att få bättre underlag om vedeldningens omfattning och emissioner har en eldningsvaneundersökning genomförts i fyra områden inom Västerbotten. Undersökningen baseras på en besöksintervju genomförd av två personer vilka följt ett formulär med frågor och standardiserat sina klassificeringar av de intervjuades svar av mer öppen karaktär. Intervjuerna har genomförts i fyra områden med bebyggelse av olika ålder: Vännäs (kommuncentra), Vännäsby, Sävar och Tavleliden/Tomtebo (villaförort i Umeå). På dessa platser har partikelmätningar i en punkt genomförts inom ramen för ett annat projekt, och kortvariga sotmätningar genomförts på fler platser. Hushåll till intervjuerna utvaldes utifrån att de enligt sotarregistret har någon form av ved- , flis- eller pelletseldning. Totalt intervjuades 176 hushåll, endast ett två ytterligare var tillfrågade och avböjde. Studien visar anläggningarnas användningsgrad, bl.a. bränsleförbrukning per år, vilket kan användas för att beräkna utsläppsmängder. För pannor fanns dock inget samband mellan hög sotnings-frekvens enligt sotarregistren och hög vedförbrukning per år enligt intervjuerna. De som har fjärrvärme som huvudsakligt uppvärmningssätt använder sin kamin/lokaleldstad mindre än den som i huvudsak värmer bostaden med el. Utsläpps- och haltberäkningar kan ta hänsyn till denna kunskap.

  • 277.
    Forsell, Karl
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden..
    Eriksson, Helena
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lundh, Monica
    Andersson, Eva
    Nilsson, Ralph
    Work environment and safety climate in the Swedish merchant fleet2017In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 90, no 2, p. 161-168Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To get knowledge of the work environment for seafarers sailing under the Swedish flag, in terms of safety climate, ergonomical, chemical and psychosocial exposures, and the seafarers self-rated health and work ability.

    METHODS: A Web-based questionnaire was sent to all seafarers with a personal e-mail address in the Swedish Maritime Registry (N = 5608). Comparisons were made mainly within the study population, using Student's t test, prevalence odds ratios and logistic regressions with 95% confidence intervals.

    RESULTS: The response rate was 35% (N = 1972; 10% women, 90% men), with 61% of the respondents working on deck, 31% in the engine room and 7% in the catering/service department (1% not classifiable). Strain on neck, arm or back and heavy lifting were associated with female gender (p = 0.0001) and younger age (below or above 30 years of age, p < 0.0001). Exposures to exhausts, oils and dust were commonly reported. Major work problems were noise, risk of an accident and vibrations from the hull of the ship. The safety climate was high in comparison with that in land-based occupations. One-fourth had experienced personal harassment or bullying during last year of service.

    CONCLUSIONS: Noise, risk of accidents, hand/arm and whole-body vibrations and psychosocial factors such as harassment were commonly reported work environment problems among seafarers within the Swedish merchant fleet.

  • 278. Fransson, Eleonor
    et al.
    de Faire, Ulf
    Ahlbom, Anders
    Reuterwall, Christina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hallqvist, Johan
    Alfredsson, Lars
    The effect of leisure-time physical activity on the risk of acute myocardial infarction depending on body mass index: a population-based case-control study.2006In: BMC Public Health, ISSN 1471-2458, Vol. 6, p. 296-Article in journal (Refereed)
  • 279. Fransson, Eleonor I
    et al.
    Heikkilä, Katriina
    Nyberg, Solja T
    Zins, Marie
    Westerlund, Hugo
    Westerholm, Peter
    Väänänen, Ari
    Virtanen, Marianna
    Vahtera, Jussi
    Theorell, Töres
    Suominen, Sakari
    Singh-Manoux, Archana
    Siegrist, Johannes
    Sabia, Séverine
    Rugulies, Reiner
    Pentti, Jaana
    Oksanen, Tuula
    Nordin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nielsen, Martin L
    Marmot, Michael G
    Magnusson Hanson, Linda L
    Madsen, Ida EH
    Lunau, Thorsten
    Leineweber, Constanze
    Kumari, Meena
    Kouvonen, Anne
    Koskinen, Aki
    Koskenvuo, Markku
    Knutsson, Anders
    Kittel, France
    Jöckel, Karl-Heinz
    Joensuu, Matti
    Houtman, Irene L
    Hooftman, Wendela E
    Goldberg, Marcel
    Geuskens, Goedele A
    Ferrie, Jane E
    Erbel, Raimund
    Dragano, Nico
    De Bacquer, Dirk
    Clays, Els
    Casini, Annalisa
    Burr, Hermann
    Borritz, Marianne
    Bonenfant, Sébastien
    Bjorner, Jakob B
    Alfredsson, Lars
    Hamer, Mark
    Batty, G David
    Kivimäki, Mika
    Job strain as a risk factor for leisure-time physical inactivity: an individual-participant meta-analysis of up to 170,000 men and women2012In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 176, no 12, p. 1078-1089Article, review/survey (Refereed)
    Abstract [en]

    Unfavorable work characteristics, such as low job control and too high or too low job demands, have been suggested to increase the likelihood of physical inactivity during leisure time, but this has not been verified in large-scale studies. The authors combined individual-level data from 14 European cohort studies (baseline years from 19851988 to 20062008) to examine the association between unfavorable work characteristics and leisure-time physical inactivity in a total of 170,162 employees (50 women; mean age, 43.5 years). Of these employees, 56,735 were reexamined after 29 years. In cross-sectional analyses, the odds for physical inactivity were 26 higher (odds ratio 1.26, 95 confidence interval: 1.15, 1.38) for employees with high-strain jobs (low control/high demands) and 21 higher (odds ratio 1.21, 95 confidence interval: 1.11, 1.31) for those with passive jobs (low control/low demands) compared with employees in low-strain jobs (high control/low demands). In prospective analyses restricted to physically active participants, the odds of becoming physically inactive during follow-up were 21 and 20 higher for those with high-strain (odds ratio 1.21, 95 confidence interval: 1.11, 1.32) and passive (odds ratio 1.20, 95 confidence interval: 1.11, 1.30) jobs at baseline. These data suggest that unfavorable work characteristics may have a spillover effect on leisure-time physical activity.

  • 280. Fransson, Eleonor I.
    et al.
    Nyberg, Solja T.
    Heikkila, Katriina
    Alfredsson, Lars
    Bacquer, De Dirk
    Batty, G. David
    Bonenfant, Sebastien
    Casini, Annalisa
    Clays, Els
    Goldberg, Marcel
    Kittel, France
    Koskenvuo, Markku
    Knutsson, Anders
    Leineweber, Constanze
    Hanson, Linda L. Magnusson
    Nordin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Singh-Manoux, Archana
    Suominen, Sakari
    Vahtera, Jussi
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Theorell, Tores
    Kivimaki, Mika
    Comparison of alternative versions of the job demand-control scales in 17 European cohort studies: the IPD-Work consortium2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, p. 62-Article in journal (Refereed)
    Abstract [en]

    Background: Job strain (i.e., high job demands combined with low job control) is a frequently used indicator of harmful work stress, but studies have often used partial versions of the complete multi-item job demands and control scales. Understanding whether the different instruments assess the same underlying concepts has crucial implications for the interpretation of findings across studies, harmonisation of multi-cohort data for pooled analyses, and design of future studies. As part of the 'IPD-Work' (Individual-participant-data meta-analysis in working populations) consortium, we compared different versions of the demands and control scales available in 17 European cohort studies. Methods: Six of the 17 studies had information on the complete scales and 11 on partial scales. Here, we analyse individual level data from 70 751 participants of the studies which had complete scales (5 demand items, 6 job control items). Results: We found high Pearson correlation coefficients between complete scales of job demands and control relative to scales with at least three items (r > 0.90) and for partial scales with two items only (r = 0.76-0.88). In comparison with scores from the complete scales, the agreement between job strain definitions was very good when only one item was missing in either the demands or the control scale (kappa > 0.80); good for job strain assessed with three demand items and all six control items (kappa > 0.68) and moderate to good when items were missing from both scales (kappa = 0.54-0.76). The sensitivity was > 0.80 when only one item was missing from either scale, decreasing when several items were missing in one or both job strain subscales. Conclusions: Partial job demand and job control scales with at least half of the items of the complete scales, and job strain indices based on one complete and one partial scale, seemed to assess the same underlying concepts as the complete survey instruments.

  • 281. Freisling, Heinz
    et al.
    Moskal, Aurelie
    Ferrari, Pietro
    Nicolas, Genevieve
    Knaze, Viktoria
    Clavel-Chapelon, Francoise
    Boutron-Ruault, Marie-Christine
    Nailler, Laura
    Teucher, Birgit
    Grote, Verena A.
    Boeing, Heiner
    Clemens, Matthias
    Tjonneland, Anne
    Olsen, Anja
    Overvad, Kim
    Ramon Quiros, J.
    Duell, Eric J.
    Sanchez, Maria-Jose
    Amiano, Pilar
    Chirlaque, Maria-Dolores
    Barricarte, Aurelio
    Khaw, Kay-Tee
    Wareham, Nicholas J.
    Crowe, Francesca L.
    Gallo, Valentina
    Oikonomou, Eleni
    Naska, Androniki
    Trichopoulou, Antonia
    Palli, Domenico
    Agnoli, Claudia
    Tumino, Rosario
    Polidoro, Silvia
    Mattiello, Amalia
    Bueno-de-Mesquita, H. Bas
    Ocke, Marga C.
    Peeters, Petra H. M.
    Wirfalt, Elisabet
    Ericson, Ulrika
    Bergdahl, Ingvar A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Hjartaker, Anette
    Engeset, Dagrun
    Skeie, Guri
    Riboli, Elio
    Slimani, Nadia
    Dietary acrylamide intake of adults in the European Prospective Investigation into Cancer and Nutrition differs greatly according to geographical region2013In: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215, Vol. 52, no 4, p. 1369-1380Article in journal (Refereed)
    Abstract [en]

    Methodological differences in assessing dietary acrylamide (AA) often hamper comparisons of intake across populations. Our aim was to describe the mean dietary AA intake in 27 centers of 10 European countries according to selected lifestyle characteristics and its contributing food sources in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. In this cross-sectional analysis, 36 994 men and women, aged 35-74 years completed a single, standardized 24-hour dietary recall using EPIC-Soft. Food consumption data were matched to a harmonized AA database. Intake was computed by gender and center, and across categories of habitual alcohol consumption, smoking status, physical activity, education, and body mass index (BMI). Adjustment was made for participants' age, height, weight, and energy intake using linear regression models. Adjusted mean AA intake across centers ranged from 13 to 47 mu g/day in men and from 12 to 39 mu g/day in women; intakes were higher in northern European centers. In most centers, intake in women was significantly higher among alcohol drinkers compared with abstainers. There were no associations between AA intake and physical activity, BMI, or education. At least 50 % of AA intake across centers came from two food groups "bread, crisp bread, rusks" and "coffee." The third main contributing food group was "potatoes". Dietary AA intake differs greatly among European adults residing in different geographical regions. This observed heterogeneity in AA intake deserves consideration in the design and interpretation of population-based studies of dietary AA intake and health outcomes.

  • 282. Fridell, Erik
    et al.
    Haeger-Eugensson, Marie
    Moldanova, Jana
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Sjöberg, Karin
    A modelling study of the impact on air quality and health due to theemissions from E85 and petrol fuelled cars in Sweden2014In: Atmospheric Environment, ISSN 1352-2310, E-ISSN 1873-2844, Vol. 82, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Alternative fuels are becoming more and more important for road traffic and one fuel that has been usedfor several years is ethanol (E85). The main discussion points regarding the environmental performancefor ethanol as a fuel are related to the production. However, there are also some notable differences inthe emissions between E85 and petrol fuelled vehicles. This relates to some extent to the emissions ofnitrogen oxides (NOx) and particulate matter (PM) but mainly to the composition of the emitted organiccompounds. In the present study two fuel scenarios for passenger cars are investigated for the VästraGötaland Region in Sweden; one where the cars with Otto engines run on petrol and one where they runon E85. Two emission scenarios for 2020 are constructed for the whole Europe and coupled dispersionchemistrymodelling is applied to obtain the population exposure to key pollutants. The differencesobtained from the modelling show decreased levels of NOx, ozone and benzene with E85 and increasedlevels of acetaldehyde in the Västra Götaland Region. For the latter the increase may be up to 80%, whileNOx and ozone show decreases of up to a few per cent and a few tenths of per cent, respectively.Exposure to the different air pollutants is calculated as population-weighted concentrations. The healthrisk assessment, using the calculated exposure and published exposureeresponse functions for therelevant pollutants, shows decreased health risks in the E85 scenario relative the all-petrol scenario, dueto the decreased NOx exposure, correlated with both preterm deaths and asthma. However, NOx (andNO2) may partly be indicators of unmeasured causal exhaust components in the epidemiological studiesand thus the exposureeresponse functions for these may not be applicable in the present case wherethere is a difference in NOx exposure but not a proportional difference in exposure to other exhaustcomponents normally associated with NOx. Smaller effects are expected from the changes in ozone,acetaldehyde, PM2.5 and benzene exposure. The overall difference is about 1.6 preterm deaths per yearfor the Västra Götaland Region, with lower values for the E85 scenario, when the uncertain differencesdue to the differences in NOx exposure are not considered.

  • 283. Fuertes, Elaine
    et al.
    Carsin, Anne-Elie
    Antó, Josep M.
    Bono, Roberto
    Corsico, Angelo Guido
    Demoly, Pascal
    Gislason, Thorarinn
    Gullón, José-Antonio
    Janson, Christer
    Jarvis, Deborah
    Heinrich, Joachim
    Holm, Mathias
    Leynaert, Bénédicte
    Marcon, Alessandro
    Martinez-Moratalla, Jesús
    Nowak, Dennis
    Erquicia, Silvia Pascual
    Probst-Hensch, Nicole M.
    Raherison, Chantal
    Raza, Wasif
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Real, Francisco Gómez
    Russell, Melissa
    Sánchez-Ramos, José Luis
    Weyler, Joost
    Aymerich, Judith Garcia
    Leisure-time vigorous physical activity is associated with better lung function: the prospective ECRHS study2018In: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 73, no 4, p. 376-384Article in journal (Refereed)
    Abstract [en]

    Objective: We assessed associations between physical activity and lung function, and its decline, in the prospective population-based European Community Respiratory Health Survey cohort. Methods: FEV1 and FVC were measured in 3912 participants at 27-57 years and 39-67 years (mean time between examinations= 11.1 years). Physical activity frequency and duration were assessed using questionnaires and used to identify active individuals (physical activity >= 2 times and >= 1 hour per week) at each examination. Adjusted mixed linear regression models assessed associations of regular physical activity with FEV1 and FVC. Results: Physical activity frequency and duration increased over the study period. In adjusted models, active individuals at the first examination had higher FEV1 (43.6 mL (95% CI 12.0 to 75.1)) and FVC (53.9 mL (95% CI 17.8 to 89.9)) at both examinations than their non-active counterparts. These associations appeared restricted to current smokers. In the whole population, FEV1 and FVC were higher among those who changed from inactive to active during the follow-up (38.0 mL (95% CI 15.8 to 60.3) and 54.2 mL (95% CI 25.1 to 83.3), respectively) and who were consistently active, compared with those consistently non-active. No associations were found for lung function decline. Conclusion: Leisure-time vigorous physical activity was associated with higher FEV1 and FVC over a 10-year period among current smokers, but not with FEV1 and FVC decline.

  • 284. Fuertes, Elaine
    et al.
    Markevych, Iana
    Jarvis, Deborah
    Vienneau, Danielle
    de Hoogh, Kees
    Antó, Josep Maria
    Bowatte, Gayan
    Bono, Roberto
    Corsico, Angelo G
    Emtner, Margareta
    Gislason, Thorarinn
    Gullón, José Antonio
    Heinrich, Joachim
    Henderson, John
    Holm, Mathias
    Johannessen, Ane
    Leynaert, Bénédicte
    Marcon, Alessandro
    Marchetti, Pierpaolo
    Moratalla, Jesús Martínez
    Pascual, Silvia
    Probst-Hensch, Nicole
    Sánchez-Ramos, José Luis
    Siroux, Valerie
    Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Weyler, Joost
    Kuenzli, Nino
    Jacquemin, Bénédicte
    Garcia-Aymerich, Judith
    Residential air pollution does not modify the positive association between physical activity and lung function in current smokers in the ECRHS study2018In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 120, p. 364-372Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Very few studies have examined whether a long-term beneficial effect of physical activity on lung function can be influenced by living in polluted urban areas.

    OBJECTIVE: We assessed whether annual average residential concentrations of nitrogen dioxide (NO2) and particulate matter with aerodynamic diameters < 2.5 μm (PM2.5) and <10 μm (PM10) modify the effect of physical activity on lung function among never- (N = 2801) and current (N = 1719) smokers in the multi-center European Community Respiratory Health Survey.

    METHODS: Associations between repeated assessments (at 27-57 and 39-67 years) of being physically active (physical activity: ≥2 times and ≥1 h per week) and forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were evaluated using adjusted mixed linear regression models. Models were conducted separately for never- and current smokers and stratified by residential long-term NO2, PM2.5 mass and PM10 mass concentrations (≤75th percentile (low/medium) versus >75th percentile (high)).

    RESULTS: Among current smokers, physical activity and lung function were positively associated regardless of air pollution levels. Among never-smokers, physical activity was associated with lung function in areas with low/medium NO2, PM2.5 mass and PM10 mass concentrations (e.g. mean difference in FVC between active and non-active subjects was 43.0 mL (13.6, 72.5), 49.5 mL (20.1, 78.8) and 49.7 mL (18.6, 80.7), respectively), but these associations were attenuated in high air pollution areas. Only the interaction term of physical activity and PM10 mass for FEV1 among never-smokers was significant (p-value = 0.03).

    CONCLUSIONS: Physical activity has beneficial effects on adult lung function in current smokers, irrespective of residential air pollution levels in Western Europe. Trends among never-smokers living in high air pollution areas are less clear.

  • 285. Fuks, Kateryna B.
    et al.
    Weinmayr, Gudrun
    Foraster, Maria
    Dratva, Julia
    Hampel, Regina
    Houthuijs, Danny
    Oftedal, Bente
    Oudin, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Panasevich, Sviatlana
    Penell, Johanna
    Nilsson Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Sørensen, Mette
    Tiittanen, Pekka
    Wolf, Kathrin
    Xun, Wei W.
    Aguilera, Inmaculada
    Basagaña, Xavier
    Beelen, Rob
    Bots, Michiel L.
    Brunekreef, Bert
    Bueno-de-Mesquita, H. Bas
    Caracciolo, Barbara
    Cirach, Marta
    de Faire, Ulf
    de Nazelle, Audrey
    Eeftens, Marloes
    Elosua, Roberto
    Erbel, Raimund
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Fratiglioni, Laura
    Gaspoz, Jean-Michel
    Hilding, Agneta
    Jula, Antti
    Korek, Michal
    Krämer, Ursula
    Künzli, Nino
    Lanki, Timo
    Leander, Karin
    Magnusson, Patrik K.
    Marrugat, Jaume
    Nieuwenhuijsen, Mark J.
    Östenson, Claes-Göran
    Pedersen, Nancy L.
    Pershagen, Göran
    Phuleria, Harish C.
    Probst-Hensch, Nicole M.
    Raaschou-Nielsen, Ole
    Schaffner, Emmanuel
    Schikowski, Tamara
    Schindler, Christian
    Schwarze, Per E.
    Søgaard, Annee J.
    Sugiri, Dorothea
    Swart, Wim J.
    Tsai, Ming-Yi
    Turunen, Anu W.
    Vineis, Paolo
    Peters, Annette
    Hoffmann, Barbara
    Arterial blood pressure and long-term exposure to traffic-related air pollution: an analysis in the European Study of Cohorts for Air Pollution Effects (ESCAPE)2014In: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 122, no 9, p. 896-905Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Long-term exposure to air pollution is hypothesized to elevate arterial blood pressure (BP). The existing evidence is scarce and country-specific. OBJECTIVES: We investigated the cross-sectional association of long-term traffic-related air pollution with BP and prevalent hypertension in European populations. METHODS: Fifteen population-based cohorts, participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE), were analysed. Residential exposure to particulate matter and nitrogen oxides was modelled with land use regression using a uniform protocol. Traffic exposure was assessed with traffic indicator variables. We analysed systolic and diastolic BP in participants medicated and non-medicated with BP lowering medication (BPLM) separately, adjusting for personal and area-level risk factors and environmental noise. Prevalent hypertension was defined as ≥ 140 mmHg systolic, or ≥ 90 mmHg diastolic BP, or intake of BPLM. We combined cohort-specific results using random-effects meta-analysis. RESULTS: In the main meta-analysis of 113,926 participants, traffic load on major roads within 100 m of the residence was associated with increased systolic and diastolic BP in non-medicated participants (0.35 mmHg [95% CI: 0.02-0.68] and 0.22 mmHg [95% CI: 0.04-0.40] per 4,000,000 vehicles × m/day, respectively). The estimated odds ratio for prevalent hypertension was 1.05 [95% CI: 0.99-1.11] per 4,000,000 vehicles × m/day. Modelled air pollutants and BP were not clearly associated. CONCLUSIONS: In this first comprehensive meta-analysis of European population-based cohorts we observed a weak positive association of high residential traffic exposure with BP in non-medicated participants, and an elevated OR for prevalent hypertension. The relationship of modelled air pollutants with BP was inconsistent.

  • 286. Garcia-Larsen, Vanessa
    et al.
    Arthur, Rhonda
    Potts, James F
    Howarth, Peter H
    Ahlström, Matti
    Haahtela, Tari
    Loureiro, Carlos
    Bom, Ana Todo
    Brożek, Grzegorz
    Makowska, Joanna
    Kowalski, Marek L
    Thilsing, Trine
    Keil, Thomas
    Matricardi, Paolo M
    Torén, Kjell
    van Zele, Thibaut
    Bachert, Claus
    Rymarczyk, Barbara
    Janson, Christer
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Niżankowska-Mogilnicka, Ewa
    Burney, Peter G J
    Is fruit and vegetable intake associated with asthma or chronic rhino-sinusitis in European adults? Results from the Global Allergy and Asthma Network of Excellence (GA(2)LEN) Survey2017In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 7, article id 3Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Fruits and vegetables are rich in compounds with proposed antioxidant, anti-allergic and anti-inflammatory properties, which could contribute to reduce the prevalence of asthma and allergic diseases.

    OBJECTIVE: We investigated the association between asthma, and chronic rhino-sinusitis (CRS) with intake of fruits and vegetables in European adults.

    METHODS: A stratified random sample was drawn from the Global Allergy and Asthma Network of Excellence (GA(2)LEN) screening survey, in which 55,000 adults aged 15-75 answered a questionnaire on respiratory symptoms. Asthma score (derived from self-reported asthma symptoms) and CRS were the outcomes of interest. Dietary intake of 22 subgroups of fruits and vegetables was ascertained using the internationally validated GA(2)LEN Food Frequency Questionnaire. Adjusted associations were examined with negative binomial and multiple regressions. Simes procedure was used to control for multiple testing.

    RESULTS: A total of 3206 individuals had valid data on asthma and dietary exposures of interest. 22.8% reported having at least 1 asthma symptom (asthma score ≥1), whilst 19.5% had CRS. After adjustment for potential confounders, asthma score was negatively associated with intake of dried fruits (β-coefficient -2.34; 95% confidence interval [CI] -4.09, -0.59), whilst CRS was statistically negatively associated with total intake of fruits (OR 0.73; 95% CI 0.55, 0.97). Conversely, a positive association was observed between asthma score and alliums vegetables (adjusted β-coefficient 0.23; 95% CI 0.06, 0.40). None of these associations remained statistically significant after controlling for multiple testing.

    CONCLUSION AND CLINICAL RELEVANCE: There was no consistent evidence for an association of asthma or CRS with fruit and vegetable intake in this representative sample of European adults.

  • 287. Garcia-Larsen, Vanessa
    et al.
    Thawer, Narjis
    Charles, David
    Cassidy, Aedin
    van Zele, Thibaut
    Thilsing, Trine
    Ahlström, Matti
    Haahtela, Tari
    Keil, Thomas
    Matricardi, Paolo M.
    Brożek, Grzegorz
    Kowalski, Marek L.
    Makowska, Joanna
    Niżankowska-Mogilnicka, Ewa
    Rymarczyk, Barbara
    Loureiro, Carlos
    Todo Bom, Ana
    Bachert, Claus
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Janson, Christer
    Torén, Kjell
    Potts, James F.
    Burney, Peter G. J.
    Dietary intake of flavonoids and ventilatory function in European adults: a GA²LEN study2018In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 10, no 1, article id 95Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Flavonoids exert anti-inflammatory properties and modulate oxidative stress in vitro, suggesting a protective effect on lung function, but epidemiological studies examining this association are scarce.

    METHODS: A stratified random sample was drawn from the GA²LEN screening survey, in which 55,000 adults aged 15 to 75 answered a questionnaire on respiratory symptoms. Post-bronchodilator spirometry was obtained from 2850 subjects. Forced vital capacity (FVC), the ratio between the forced exhaled volume in 1 second (FEV₁) and FVC (FEV₁/FVC), FVC below lower limit of normal (FVC < LLN), and FEV₁/FVC < LLN were calculated. Intake of the six main subclasses of flavonoids was estimated using the GA²LEN Food Frequency Questionnaire. Adjusted associations between outcomes and each subclass of flavonoids were examined with multivariate regressions. Simes' procedure was used to test for multiple comparisons.

    RESULTS: A total of 2599 subjects had valid lung function and dietary data. A lower prevalence of FVC < LLN (airway restriction) was observed in those with higher total flavonoid (adjusted odds ratio (aOR), higher vs. lowest quintile intake 0.58; 95% Confidence Interval (CI) 0.36, 0.94), and pro-anthocyanidin intakes (aOR 0.47; 95% CI 0.27, 0.81). A higher FEV₁/FVC was associated with higher intakes of total flavonoids and pro-anthocyanidins (adjusted correlation coefficient (a β-coeff 0.33; 0.10, 0.57 and a β-coeff 0.44; 95% CI 0.19, 0.69, respectively). After Simes' procedure, the statistical significance of each of these associations was attenuated but remained below 0.05, with the exception of total flavonoids and airway restriction.

    CONCLUSIONS: This population-based study in European adults provides cross-sectional evidence of a positive association of total flavonoid intake and pro-anthocyanidins and ventilatory function, and a negative association with spirometric restriction in European adults.

  • 288. Garde, Anne Helene
    et al.
    Karlsson, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hansen, Åse Marie
    Persson, Roger
    Åkerstedt, Torbjörn
    Sleep and Salivary Cortisol2012In: The Role of Saliva Cortisol Measurement in Health and Disease / [ed] Margareta Kristenson, Peter Garvin, Ulf Lundberg, Bentham eBooks, 2012, p. 116-128Chapter in book (Other academic)
    Abstract [en]

    The aim of the present chapter was to analyze whether measures of cortisol in saliva were associated with measures of sleep and to explore if divergent results were related to underlying differences in theoretic assumptions and methods. Measures of sleep quality included sleep duration, overall sleep quality, difficulty falling asleep, disturbed sleep, and sleep deprivation. Twenty-three papers were found to fulfil the inclusion criteria. Cortisol measures were grouped into single time points at different times during the day, deviations at different time periods during the day, reactivity and recovery after a standardized laboratory test, area under the curve and response to dexamethasone test. A large proportion of the studies included showed nonsignificant findings, which, in several cases, may be a result of low power. The most consistent results were a positive association between sleep duration and single measures of salivary cortisol at awakening, which was observed in 3 studies. In these studies, sleep duration was also associated with low evening cortisol levels, steep diurnal deviation of cortisol and/or high area under the curve. Together these findings suggest that longer sleep duration is related to a more dynamic cortisol secretion. Two of the 6 studies on disturbed or restless sleep showed relations to flat diurnal deviation and low laboratory stress test reactivity. This to some extent corroborates the findings on sleep duration. However, the many nonsignificant findings as well as the theoretical and methodological differences (e.g., heterogeneity in measures) complicate comparisons. Conflicting results may be at least partially due to differences in methods and underlying assumptions.

  • 289. Gasparrini, Antonio
    et al.
    Guo, Yuming
    Hashizume, Masahiro
    Lavigne, Eric
    Zanobetti, Antonella
    Schwartz, Joel
    Tobias, Aurelio
    Tong, Shilu
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Leone, Michela
    De Sario, Manuela
    Bell, Michelle L
    Guo, Yue-Liang Leon
    Wu, Chang-Fu
    Kan, Haidong
    Yi, Seung-Muk
    de Sousa Zanotti Stagliorio Coelh, Micheline
    Saldiva, Paulo Hilario Nascimento
    Honda, Yasushi
    Kim, Ho
    Armstrong, Ben
    Mortality risk attributable to high and low ambient temperature: a multicountry observational study2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 9991, p. 369-375Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although studies have provided estimates of premature deaths attributable to either heat or cold in selected countries, none has so far offered a systematic assessment across the whole temperature range in populations exposed to different climates. We aimed to quantify the total mortality burden attributable to non-optimum ambient temperature, and the relative contributions from heat and cold and from moderate and extreme temperatures.

    METHODS: We collected data for 384 locations in Australia, Brazil, Canada, China, Italy, Japan, South Korea, Spain, Sweden, Taiwan, Thailand, UK, and USA. We fitted a standard time-series Poisson model for each location, controlling for trends and day of the week. We estimated temperature-mortality associations with a distributed lag non-linear model with 21 days of lag, and then pooled them in a multivariate metaregression that included country indicators and temperature average and range. We calculated attributable deaths for heat and cold, defined as temperatures above and below the optimum temperature, which corresponded to the point of minimum mortality, and for moderate and extreme temperatures, defined using cutoffs at the 2·5th and 97·5th temperature percentiles.

    FINDINGS: We analysed 74 225 200 deaths in various periods between 1985 and 2012. In total, 7·71% (95% empirical CI 7·43-7·91) of mortality was attributable to non-optimum temperature in the selected countries within the study period, with substantial differences between countries, ranging from 3·37% (3·06 to 3·63) in Thailand to 11·00% (9·29 to 12·47) in China. The temperature percentile of minimum mortality varied from roughly the 60th percentile in tropical areas to about the 80-90th percentile in temperate regions. More temperature-attributable deaths were caused by cold (7·29%, 7·02-7·49) than by heat (0·42%, 0·39-0·44). Extreme cold and hot temperatures were responsible for 0·86% (0·84-0·87) of total mortality.

    INTERPRETATION: Most of the temperature-related mortality burden was attributable to the contribution of cold. The effect of days of extreme temperature was substantially less than that attributable to milder but non-optimum weather. This evidence has important implications for the planning of public-health interventions to minimise the health consequences of adverse temperatures, and for predictions of future effect in climate-change scenarios.

    FUNDING: UK Medical Research Council.

  • 290. Gasparrini, Antonio
    et al.
    Guo, Yuming
    Sera, Francesco
    Vicedo-Cabrera, Ana Maria
    Huber, Veronika
    Tong, Shilu
    de Sousa Zanotti Stagliorio Coelho, Micheline
    Nascimento Saldiva, Paulo Hilario
    Lavigne, Eric
    Matus Correa, Patricia
    Valdes Ortega, Nicolas
    Kan, Haidong
    Osorio, Samuel
    Kyselý, Jan
    Urban, Aleš
    Jaakkola, Jouni J. K.
    Ryti, Niilo R. I.
    Pascal, Mathilde
    Goodman, Patrick G.
    Zeka, Ariana
    Michelozzi, Paola
    Scortichini, Matteo
    Hashizume, Masahiro
    Honda, Yasushi
    Hurtado-Diaz, Magali
    Cesar Cruz, Julio
    Seposo, Xerxes
    Kim, Ho
    Tobias, Aurelio
    Iñiguez, Carmen
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Oudin Åström, Daniel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ragettli, Martina S.
    Guo, Yue Leon
    Wu, Chang-Fu
    Zanobetti, Antonella
    Schwartz, Joel
    Bell, Michelle L.
    Dang, Tran Ngoc
    Van, Dung Do
    Heaviside, Clare
    Vardoulakis, Sotiris
    Hajat, Shakoor
    Haines, Andy
    Armstrong, Ben
    Projections of temperature-related excess mortality under climate change scenarios2017In: The Lancet Planetary Health, ISSN 2542-5196, Vol. 1, no 9, p. e360-e367Article in journal (Refereed)
    Abstract [en]

    Background: Climate change can directly affect human health by varying exposure to non-optimal outdoor temperature. However, evidence on this direct impact at a global scale is limited, mainly due to issues in modelling and projecting complex and highly heterogeneous epidemiological relationships across different populations and climates.

    Methods: We collected observed daily time series of mean temperature and mortality counts for all causes or non-external causes only, in periods ranging from Jan 1, 1984, to Dec 31, 2015, from various locations across the globe through the Multi-Country Multi-City Collaborative Research Network. We estimated temperature-mortality relationships through a two-stage time series design. We generated current and future daily mean temperature series under four scenarios of climate change, determined by varying trajectories of greenhouse gas emissions, using five general circulation models. We projected excess mortality for cold and heat and their net change in 1990-2099 under each scenario of climate change, assuming no adaptation or population changes.

    Findings: Our dataset comprised 451 locations in 23 countries across nine regions of the world, including 85 879 895 deaths. Results indicate, on average, a net increase in temperature-related excess mortality under high-emission scenarios, although with important geographical differences. In temperate areas such as northern Europe, east Asia, and Australia, the less intense warming and large decrease in cold-related excess would induce a null or marginally negative net effect, with the net change in 2090-99 compared with 2010-19 ranging from -1·2% (empirical 95% CI -3·6 to 1·4) in Australia to -0·1% (-2·1 to 1·6) in east Asia under the highest emission scenario, although the decreasing trends would reverse during the course of the century. Conversely, warmer regions, such as the central and southern parts of America or Europe, and especially southeast Asia, would experience a sharp surge in heat-related impacts and extremely large net increases, with the net change at the end of the century ranging from 3·0% (-3·0 to 9·3) in Central America to 12·7% (-4·7 to 28·1) in southeast Asia under the highest emission scenario. Most of the health effects directly due to temperature increase could be avoided under scenarios involving mitigation strategies to limit emissions and further warming of the planet.

    Interpretation: This study shows the negative health impacts of climate change that, under high-emission scenarios, would disproportionately affect warmer and poorer regions of the world. Comparison with lower emission scenarios emphasises the importance of mitigation policies for limiting global warming and reducing the associated health risks.

  • 291. Gasull, Magda
    et al.
    Pumarega, José
    Kiviranta, Hannu
    Rantakokko, Panu
    Raaschou-Nielsen, Ole
    Bergdahl, Ingvar A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Sandanger, Torkjel Manning
    Goñi, Fernando
    Cirera, Lluís
    Donat-Vargas, Carolina
    Alguacil, Juan
    Iglesias, Mar
    Tjønneland, Anne
    Overvad, Kim
    Mancini, Francesca Romana
    Boutron-Ruault, Marie-Christine
    Severi, Gianluca
    Johnson, Theron
    Kühn, Tilman
    Trichopoulou, Antonia
    Karakatsani, Anna
    Peppa, Eleni
    Palli, Domenico
    Pala, Valeria
    Tumino, Rosario
    Naccarati, Alessio
    Panico, Salvatore
    Verschuren, Monique
    Vermeulen, Roel
    Rylander, Charlotta
    Haugdahl Nøst, Therese
    Rodríguez-Barranco, Miguel
    Molinuevo, Amaia
    Chirlaque, María-Dolores
    Ardanaz, Eva
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Key, Tim
    Ye, Weimin
    Umeå University, Faculty of Medicine, Department of Biobank Research. Department of Medical Epidemiology and Biostatistics Karolinska Institutet, Stockholm, Sweden.
    Jenab, Mazda
    Michaud, Dominique
    Matullo, Giuseppe
    Canzian, Federico
    Kaaks, Rudolf
    Nieters, Alexandra
    Nöthlings, Ute
    Jeurnink, Suzanne
    Chajes, Veronique
    Matejcic, Marco
    Gunter, Marc
    Aune, Dagfinn
    Riboli, Elio
    Agudo, Antoni
    Gonzalez, Carlos Alberto
    Weiderpass, Elisabete
    Bueno-de-Mesquita, Bas
    Duell, Eric J.
    Vineis, Paolo
    Porta, Miquel
    Methodological issues in a prospective study on plasma concentrations of persistent organic pollutants and pancreatic cancer risk within the EPIC cohort2019In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 169, p. 417-433Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The use of biomarkers of environmental exposure to explore new risk factors for pancreatic cancer presents clinical, logistic, and methodological challenges that are also relevant in research on other complex diseases.

    OBJECTIVES: First, to summarize the main design features of a prospective case-control study -nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort- on plasma concentrations of persistent organic pollutants (POPs) and pancreatic cancer risk. And second, to assess the main methodological challenges posed by associations among characteristics and habits of study participants, fasting status, time from blood draw to cancer diagnosis, disease progression bias, basis of cancer diagnosis, and plasma concentrations of lipids and POPs. Results from etiologic analyses on POPs and pancreatic cancer risk, and other analyses, will be reported in future articles.

    METHODS: Study subjects were 1533 participants (513 cases and 1020 controls matched by study centre, sex, age at blood collection, date and time of blood collection, and fasting status) enrolled between 1992 and 2000. Plasma concentrations of 22 POPs were measured by gas chromatography - triple quadrupole mass spectrometry (GC-MS/MS). To estimate the magnitude of the associations we calculated multivariate-adjusted odds ratios by unconditional logistic regression, and adjusted geometric means by General Linear Regression Models.

    RESULTS: There were differences among countries in subjects' characteristics (as age, gender, smoking, lipid and POP concentrations), and in study characteristics (as time from blood collection to index date, year of last follow-up, length of follow-up, basis of cancer diagnosis, and fasting status). Adjusting for centre and time of blood collection, no factors were significantly associated with fasting status. Plasma concentrations of lipids were related to age, body mass index, fasting, country, and smoking. We detected and quantified 16 of the 22 POPs in more than 90% of individuals. All 22 POPs were detected in some participants, and the smallest number of POPs detected in one person was 15 (median, 19) with few differences by country. The highest concentrations were found for p,p'-DDE, PCBs 153 and 180 (median concentration: 3371, 1023, and 810 pg/mL, respectively). We assessed the possible occurrence of disease progression bias (DPB) in eight situations defined by lipid and POP measurements, on one hand, and by four factors: interval from blood draw to index date, tumour subsite, tumour stage, and grade of differentiation, on the other. In seven of the eight situations results supported the absence of DPB.

    CONCLUSIONS: The coexistence of differences across study centres in some design features and participant characteristics is of relevance to other multicentre studies. Relationships among subjects' characteristics and among such characteristics and design features may play important roles in the forthcoming analyses on the association between plasma concentrations of POPs and pancreatic cancer risk.

  • 292. Gaudet, Mia M
    et al.
    Deubler, Emily L
    Kelly, Rachel S
    Diver, W Ryan
    Teras, Lauren R
    Hodge, James M
    Levine, Keith E
    Haines, Laura G
    Lundh, Thomas
    Lenner, Per
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Palli, Domenico
    Vineis, Paolo
    Bergdahl, Ingvar
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Gapstur, Susan M
    Kyrtopoulos, Soterios A
    Blood Levels of Cadmium and Lead in Relation to Breast Cancer Risk in Three Prospective Cohorts.2019In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 144, no 5, p. 1010-1016Article in journal (Refereed)
    Abstract [en]

    Cadmium and lead have been classified as carcinogens by the International Agency for Research on Cancer. However, their associations with breast cancer risk are unknown despite their persistence in the environment and ubiquitous human exposure. We examined associations of circulating levels of cadmium and lead with breast cancer risk in three case-control studies nested within the Cancer Prevention Study-II (CPS-II) LifeLink Cohort, European Prospective Investigation into Cancer and Nutrition - Italy (EPIC-Italy), and the Northern Sweden Health and Disease Study (NSHDS) cohorts. Metal levels were measured in stored erythrocytes from 1,435 cases and 1,433 controls using inductively coupled plasma-mass spectrometry. Summary relative risks (RR) and 95% confidence intervals (CI) were calculated using random-effects models with each study result weighted by the within- and between-study variances. I2 values were calculated to estimate proportion of between study variation. Using common cut-points, cadmium levels were not associated with breast cancer risk in the CPS-II cohort (continuous RR=1.01, 95% CI 0.76 - 1.34), but were inversely associated with risk in the EPIC- Italy (continuous RR=0.80, 95% CI 0.61 - 1.03) and NSHDS cohorts (continuous RR=0.73, 95% CI 0.54 - 0.97). The inverse association was also evident in the meta-analysis (continuous RR=0.84, 95% CI 0.69 - 1.01) with low between-study heterogeneity. Large differences in lead level distributions precluded a meta-analysis of their association with breast cancer risk; no associations were found in the three studies. Adult cadmium and lead levels were not associated with higher risk of breast cancer in our large meta-analysis. 

  • 293. Geale, Kirk
    et al.
    Darabi, Hatef
    Eklund, Oskar
    Lindh, Maria
    Wahl, Hanna Fues
    Ström, Oskar
    Cao, Hui
    Alvares, Luisa
    Dodge, Rikke
    Loefroth, Emil
    Altraja, Alan
    Backer, Vibecke
    Backman, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Bjermer, Leif
    Bossios, Apostolos
    Dahlén, Barbro
    Janson, Christer
    Kankaanranta, Hannu
    Kauppi, Paula
    Kilpelainen, Maritta
    Lehtimäki, Lauri
    Sandström, Thomas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Ulrik, Charlotte Suppli
    Viinanen, Arja
    Porsbjerg, Celeste
    Late Breaking Abstract - NORdic Database for aSThmA Research (NORDSTAR): Swedish and Finnish patients2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal (Other academic)
    Abstract [en]

    Background: A cross-border research collaboration was recently initiated across the Nordic countries. These countries maintain population-based registers containing a variety of patient-level health and socioeconomic variables, providing a basis for nation-wide, longitudinal research.

    Aims and objectives: Describe key characteristics of Swedish and Finnish asthma populations in 2014.

    Methods: NORDSTAR is a research platform with ethical approval based on Nordic register data. Patients with an asthma diagnosis (ICD-10: J45/46) at any age in specialist care, or ≥2 dispensed respiratory prescriptions (ATC: R03) while aged 6-44, during 2004-2014 were included. Those with diagnosis and treatment pairs unlikely to be asthma were excluded. Demographics (age, sex, income, education level, and urban residence), treatment, comorbidities, and asthma specialist visits in 2014 were described using summary statistics.

    Results: Finnish comorbidity levels appeared higher than in Sweden. More Finnish patients filled OCS prescriptions (24%) than Swedish patients (20%). Most Swedish patients lived in an urban setting, and the distribution of education level was similar to the general population. Mean family income was 49,960 and 42,840 EUR in Sweden and Finland respectively, while 31% and 44% of patients visited an asthma specialist. Prevalence of asthma was highest among women in both countries, and age distributions were similar.

    Conclusions: NORDSTAR is a platform for conducting asthma outcomes research in the Nordics. Swedish and Finnish patients appear to be similar in many dimensions except for prevalence of asthma specialist care contacts.

  • 294. Georgiadis, Panagiotis
    et al.
    Gavriil, Marios
    Rantakokko, Panu
    Ladoukakis, Efthymios
    Botsivali, Maria
    Kelly, Rachel S
    Bergdahl, Ingvar
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Kiviranta, Hannu
    Vermeulen, Roel C H
    Späth, Florentin
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Hebbels, Dennie G A J
    Kleinjans, Jos C S
    de Kok, Theo M C M
    Palli, Domenico
    Vineis, Paolo
    Kyrtopoulos, Soterios A
    DNA methylation profiling implicates exposure to PCBs in the pathogenesis of B-cell chronic lymphocytic leukemia2019In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 126, p. 24-36Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To characterize the impact of PCB exposure on DNA methylation in peripheral blood leucocytes and to evaluate the corresponding changes in relation to possible health effects, with a focus on B-cell lymphoma.

    METHODS: We conducted an epigenome-wide association study on 611 adults free of diagnosed disease, living in Italy and Sweden, in whom we also measured plasma concentrations of 6 PCB congeners, DDE and hexachlorobenzene.

    RESULTS: We identified 650 CpG sites whose methylation correlates strongly (FDR < 0.01) with plasma concentrations of at least one PCB congener. Stronger effects were observed in males and in Sweden. This epigenetic exposure profile shows extensive and highly statistically significant overlaps with published profiles associated with the risk of future B-cell chronic lymphocytic leukemia (CLL) as well as with clinical CLL (38 and 28 CpG sites, respectively). For all these sites, the methylation changes were in the same direction for increasing exposure and for higher disease risk or clinical disease status, suggesting an etiological link between exposure and CLL. Mediation analysis reinforced the suggestion of a causal link between exposure, changes in DNA methylation and disease. Disease connectivity analysis identified multiple additional diseases associated with differentially methylated genes, including melanoma for which an etiological link with PCB exposure is established, as well as developmental and neurological diseases for which there is corresponding epidemiological evidence. Differentially methylated genes include many homeobox genes, suggesting that PCBs target stem cells. Furthermore, numerous polycomb protein target genes were hypermethylated with increasing exposure, an effect known to constitute an early marker of carcinogenesis.

    CONCLUSIONS: This study provides mechanistic evidence in support of a link between exposure to PCBs and the etiology of CLL and underlines the utility of omic profiling in the evaluation of the potential toxicity of environmental chemicals.

  • 295. Georgiadis, Panagiotis
    et al.
    Hebels, Dennie G
    Valavanis, Ioannis
    Liampa, Irene
    Bergdahl, Ingvar A
    Umeå University, Faculty of Medicine, Department of Biobank Research. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Johansson, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Palli, Domenico
    Chadeau-Hyam, Marc
    Chatziioannou, Aristotelis
    Jennen, Danyel G J
    Krauskopf, Julian
    Jetten, Marlon J
    Kleinjans, Jos C S
    Vineis, Paolo
    Kyrtopoulos, Soterios A
    Omics for prediction of environmental health effects: Blood leukocyte-based cross-omic profiling reliably predicts diseases associated with tobacco smoking.2016In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 6, article id 20544Article in journal (Refereed)
    Abstract [en]

    The utility of blood-based omic profiles for linking environmental exposures to their potential health effects was evaluated in 649 individuals, drawn from the general population, in relation to tobacco smoking, an exposure with well-characterised health effects. Using disease connectivity analysis, we found that the combination of smoking-modified, genome-wide gene (including miRNA) expression and DNA methylation profiles predicts with remarkable reliability most diseases and conditions independently known to be causally associated with smoking (indicative estimates of sensitivity and positive predictive value 94% and 84%, respectively). Bioinformatics analysis reveals the importance of a small number of smoking-modified, master-regulatory genes and suggest a central role for altered ubiquitination. The smoking-induced gene expression profiles overlap significantly with profiles present in blood cells of patients with lung cancer or coronary heart disease, diseases strongly associated with tobacco smoking. These results provide proof-of-principle support to the suggestion that omic profiling in peripheral blood has the potential of identifying early, disease-related perturbations caused by toxic exposures and may be a useful tool in hazard and risk assessment.

  • 296. Georgiadis, Panagiotis
    et al.
    Liampa, Irene
    Hebels, Dennie G
    Krauskopf, Julian
    Chatziioannou, Aristotelis
    Valavanis, Ioannis
    de Kok, Theo M C M
    Kleinjans, Jos C S
    Bergdahl, Ingvar A
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Melin, Beatrice
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Spaeth, Florentin
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Palli, Domenico
    Vermeulen, R C H
    Vlaanderen, J
    Chadeau-Hyam, Marc
    Vineis, Paolo
    Kyrtopoulos, Soterios A
    Evolving DNA methylation and gene expression markers of B-cell chronic lymphocytic leukemia are present in pre-diagnostic blood samples more than 10 years prior to diagnosis2017In: BMC Genomics, ISSN 1471-2164, E-ISSN 1471-2164, Vol. 18, article id 728Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: B-cell chronic lymphocytic leukemia (CLL) is a common type of adult leukemia. It often follows an indolent course and is preceded by monoclonal B-cell lymphocytosis, an asymptomatic condition, however it is not known what causes subjects with this condition to progress to CLL. Hence the discovery of prediagnostic markers has the potential to improve the identification of subjects likely to develop CLL and may also provide insights into the pathogenesis of the disease of potential clinical relevance.

    RESULTS: We employed peripheral blood buffy coats of 347 apparently healthy subjects, of whom 28 were diagnosed with CLL 2.0-15.7 years after enrollment, to derive for the first time genome-wide DNA methylation, as well as gene and miRNA expression, profiles associated with the risk of future disease. After adjustment for white blood cell composition, we identified 722 differentially methylated CpG sites and 15 differentially expressed genes (Bonferroni-corrected p < 0.05) as well as 2 miRNAs (FDR < 0.05) which were associated with the risk of future CLL. The majority of these signals have also been observed in clinical CLL, suggesting the presence in prediagnostic blood of CLL-like cells. Future CLL cases who, at enrollment, had a relatively low B-cell fraction (<10%), and were therefore less likely to have been suffering from undiagnosed CLL or a precursor condition, showed profiles involving smaller numbers of the same differential signals with intensities, after adjusting for B-cell content, generally smaller than those observed in the full set of cases. A similar picture was obtained when the differential profiles of cases with time-to-diagnosis above the overall median period of 7.4 years were compared with those with shorted time-to-disease. Differentially methylated genes of major functional significance include numerous genes that encode for transcription factors, especially members of the homeobox family, while differentially expressed genes include, among others, multiple genes related to WNT signaling as well as the miRNAs miR-150-5p and miR-155-5p.

    CONCLUSIONS: Our findings demonstrate the presence in prediagnostic blood of future CLL patients, more than 10 years before diagnosis, of CLL-like cells which evolve as preclinical disease progresses, and point to early molecular alterations with a pathogenetic potential.

  • 297. Gerdtham, Ulf-Göran
    et al.
    Andersson, L Fredrik
    Ericsson, Asa
    Borg, Sixten
    Jansson, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lundbäck, Bo
    Factors affecting chronic obstructive pulmonary disease (COPD)-related costs: a multivariate analysis of a Swedish COPD cohort.2009In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 10, no 2, p. 217-26Article in journal (Refereed)
    Abstract [en]

    Chronic obstructive pulmonary disease (COPD) is an increasing public health problem, generating considerable costs. The objective of this study was to identify factors affecting COPD-related costs. A cohort of 179 subjects with COPD was interviewed over the telephone on four occasions about their annual use of COPD-related resources. The data set and explanatory variables were analysed by means of multivariate regression techniques for six different types of cost: societal (or total), direct (health care) and indirect (productivity), and three subcomponents of direct costs-hospitalisation, outpatient and medication. Poor lung function, dyspnoea and asthma were independently associated with higher costs. Poor lung function (severity of COPD) significantly increased all six examined cost types. Dyspnoea (breathing problems) also increased costs, though to a varying extent. The presence of reported asthma increased total, direct, outpatient and medication costs. Poor lung function and, to a lesser extent, extent of dyspnoea and concomitant asthma, were all strongly associated with higher COPD-related costs. Strong efforts should be made to prevent the progression of COPD and its symptoms.

  • 298. Gerhardsson, Lars
    et al.
    Akantis, Anna
    Lundström, Nils-Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nordberg, Gunnar F
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Schütz, Andrejs
    Skerfving, Staffan
    Lead concentrations in cortical and trabecular bones in deceased smelter workers.2005In: J Trace Elem Med Biol, ISSN 0946-672X, Vol. 19, no 2-3, p. 209-15Article in journal (Refereed)
  • 299. Gerhardsson, Lars
    et al.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hagberg, Mats
    Lundström, Ronnie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Quantitative neurosensory findings, symptoms and signs in young vibration exposed workers2013In: Journal of Occupational Medicine and Toxicology, ISSN 1745-6673, E-ISSN 1745-6673, Vol. 8, p. 8-Article in journal (Refereed)
    Abstract [en]

    Background: Long-term exposure to hand-held vibrating tools may cause the hand arm vibration syndrome (HAVS) including vibration induced white fingers and sensorineural symptoms. The aim was to study early neurosensory effects by quantitative vibrotactile and monofilament tests in young workers with hand-held vibration exposure.

    Methods: This cross-sectional study consisted of 142 young, male machine shop and construction workers with hand-held exposure to vibrating tools. They were compared with 41 non-vibration exposed subjects of the same age-group. All participants passed a structured interview, answered several questionnaires and had a physical examination including the determination of vibrotactile perception thresholds (VPTs) at two frequencies (31.5 and 125 Hz) and Semmes Weinstein's Monofilament test.

    Results: In the vibration exposed group 8% of the workers reported episodes of tingling sensations and 10% numbness in their fingers. Approximately 5-10% of the exposed population displayed abnormal results on monofilament tests. The vibrotactile testing showed significantly increased VPTs for 125 Hz in dig II bilaterally (right hand, p = 0.01; left hand, p = 0.024) in the vibration exposed group. A multiple regression analysis (VPT - dependent variable; age, height, examiner and five different vibration dose calculations - predictor variables) in dig II bilaterally showed rather low R-2-values. None of the explanatory variables including five separately calculated vibration doses were included in the models, neither for the total vibration exposed group, nor for the highest exposed quartile. A logistic multiple regression analysis (result of monofilament testing - dependent variable; age, height, examiner and five vibration dose calculations - predictor variables) of the results of monofilament testing in dig II bilaterally gave a similar outcome. None of the independent variables including five calculated vibration doses were included in the models neither for the total exposed group nor for the highest exposed quartile.

    Conclusion: In spite of the fairly short vibration exposure, a tendency to raised VPTs as well as pathologic monofilament test results was observed. Thus, early neurophysiologic symptoms and signs of vibration exposure may appear after short-term exposure also in young workers.

  • 300. Gerhardsson, Lars
    et al.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hagberg, Mats
    Lunsdström, Ronnie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    NEUROPHYSIOLOGIC SYMPTOMS AND VIBRATION PERCEPTION THRESHOLDSIN YOUNG VIBRATION-ExpOSED WORKERS: A FOLLOW-UP STUDY2011In: Canadian Acoustics, ISSN 0711-6659, E-ISSN 2291-1391, Vol. 39, no 2, p. 16-17Article in journal (Refereed)
    Abstract [en]

    Vibration exposure may cause the hand-arm vibration syndrome (HAVS), including digital vasospasms (vibration white fingers; VWF), sensorineural symptoms and/or muscular weakness and fatigue (Gemne, 1997). Neurophysiologic symptoms include numbness and/or tingling, impaired touch sensitivity, impaired manual dexterity and reduced grip strength in the hands. The Stockholm Workshop Scale is commonly used for sensorineural (SN) staging (OSN - 3 SN). Sensorineural symptoms of this in combination with difficulties in handling small objects may interfere both with the workers social- and work-related activities (Sakakibara et al., 2005).

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